MP40-20 CAN WE PREDICT FOR MISSED CLINICALLY SIGNIFICANT PROSTATE CANCERS ON MRI-TARGETED BIOPSY ALONE?

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP40-20 CAN WE PREDICT FOR MISSED CLINICALLY SIGNIFICANT PROSTATE CANCERS ON MRI-TARGETED BIOPSY ALONE? Woon Chau Tsang, Kaiying Wang, Abner Quek, Ziting Wang, Edmund Chiong, and Qinghui Wu Woon Chau TsangWoon Chau Tsang More articles by this author , Kaiying WangKaiying Wang More articles by this author , Abner QuekAbner Quek More articles by this author , Ziting WangZiting Wang More articles by this author , Edmund ChiongEdmund Chiong More articles by this author , and Qinghui WuQinghui Wu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003278.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: MRI-Targeted prostate biopsy (TBx) strategy has been shown to diagnose more clinically significant prostate cancer (csPCa) and less clinically insignificant prostate cancer (ciPCa). Currently, the yield of systematic or saturation biopsy in addition to TBx remains remain unclear. This study aims to evaluate for factors that may predict for csPCa that are missed on TBx alone. METHODS: From 2015 to 2022, we collected prospective single-centre data of consecutive patients who underwent prostate biopsy. We included patients who were biopsy-naïve, had prior negative biopsies, or were on active surveillance for low risk prostate cancer. mpMRI-ultrasound fusion-guided robotic-assisted TBx was performed for every lesion of Prostate Imaging Reporting and Data System (PIRADS) 3 and above, and every patient additionally received saturation biopsy (SBx). Patient data, MRI lesion characteristics, PIRADS score and biopsy results were evaluated. csPCa was defined as ISUP grade group 2 and above. RESULTS: 499 men underwent combined TBx and SBx. The median serum PSA was 7.31ug/L. The overall cancer detection rate was 65.7%, where csPCa rate was 45.1%. The overall cancer and csPCa rates for TBx only vs TBx plus SBx, was 52.9% vs 65.7% (p<0.01), and 39.9% vs 45.1% (p=0.10) respectively. If only TBx was performed, 19.5% of all cancers and 11.5% of csPCa would have been missed. Patients with missed csPCa on TBx only had lower PSA (7.75 vs 10.6, p<0.01), higher prostate volume (59.5 vs 42.9cc, p=0.04), and lower PSA density (0.164 vs 0.271, p<0.01). They also had lower prostate health index (PHI) score (50.6 vs 61.9, p=0.04), although PHI density was similar (1.22 vs 1.56, p=0.09). A smaller index lesion diameter was also predictive of missed csPCa on TBx (8.70 vs 12.2 mm, p<0.01). Patients with PIRADS 3 index lesions were more likely to have missed csPCa on TBx than PIRADS 4 and 5, with a missed csPCa rate of 25.8% vs 11.8% vs 3.45% (p<0.01) respectively. Age, number of lesions on mpMRI, and indication for biopsy were not predictive of missed csPCa. CONCLUSIONS: In our series, TBx alone strategy can miss 11.5% of csPCa. Factors predictive of missed csPCa include initial low PSA level, larger prostate volume, low PSA density, low PHI, small index lesion diameter and lower PIRADS score of the index lesion. A nomogram is created to aid decision making on patient selection to omit systematic biopsy when performing TBx. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e553 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Woon Chau Tsang More articles by this author Kaiying Wang More articles by this author Abner Quek More articles by this author Ziting Wang More articles by this author Edmund Chiong More articles by this author Qinghui Wu More articles by this author Expand All Advertisement PDF downloadLoading ...